Table 5.
Review of the studies investigating the clinical role for PVG/PAG stimulation for the treatment of pain
| Study, Year | Study Type | Pain Type | Total-(Implanted)-Success | Electrode and Stimulation Parameters | Side Effects | Notes |
|---|---|---|---|---|---|---|
| Boethius et al,24 1976 | Please see entry in the IC Section | |||||
| Richardsen & Akil,84 1977 | CS | PLP, CP, TPS | 6-3 | Radionics, Monopolar, stainless steel electrode, 25–75 Hz, 0.5–5 V | Nystagmus, vertigo, nausea | Five patients had an electrode over the PVG |
| Richardsen & Akil,85 1977 | CS | SCI, CP, PI, BP | 8-7-7 | Medtronic, 0–250 Hz, 0.250 ms, 0–4 V | Paresthesias, relaxation, dizziness, anxiety | F-U: 2–18 mo |
| Hosobuchi et al,90 1977 | CS PC |
CP, PN, AD | 6-6-5 | Medtronic, 10–20 Hz, 0.2–1.2 ms, 3–4 V | Oscillopsia, ocular fluttering, nausea, hot feeling, stimulation tolerance | Patient developed tolerance, stopped stimulation, and tolerance decreased, F-U: 3–18 mo |
| Meyerson et al,76 1978 | CS | CP | 9-7 | Custom, platinum-iridium, 4–6 contacts, NFS | Transient diplopia, pleasant warmth spreading to body | Used l-Dopa, F-U: average 3 mo |
| Hosobuchi et al,25 1979 | CS | PCD, TPS, LA, CP | 6-6 | Medtronic, PV(A)G, 5–20 Hz, 3–10 V; IC, 50–75 Hz, 3–5 V | IC electrodes | |
| Turnbull et al,39 1980 | Please see entry in the STH Section | |||||
| Dieckmann & Witzmann,91 1982 | CS | PI, PLP, AD, TPS, PP, PHP, PCD | 52: 23 PVG/PAG & 23 STH-32 | Multiple platinum electrode types, NFS | F-U: 6–30 mo | |
| Plotkin,40 1982 | CS | FBS, CP, PP, STP, BP | 48-38 | Medtronic, NFS | NFS | STH electrodes (12 reported, NFS); F-U: 6–42 mo |
| Boivie & Meyerson,92 1982 | CS | CP | 5-5-4 | 6-Pole, platinum iridium, 30 Hz, 0.2 ms, 0.2–0.4 mA | Pleasant feeling of warmth | Confirmed anatomic location; F-U 1–17 mo |
| Hosobuchi,44 1983 | CS | BP, LP, CIP | 11-11-11 | Medtronic, 2–60 Hz, 0–10 V, 0.1–0.5 ms | Paresthesia with VPLP/VPM, headache with dual stimulation | Dual implant of PAG and STH, F-U: 12–36 mo |
| Tsubowkawa et al,27 1984 | Please see entry in the STH Section | |||||
| Schvarcz,18 1985 | Please see entry in Septal Section | |||||
| Young et al,30 1985 | CS | FBS, CP, SCI, PHP, PI | 48-43-38 | Medtronic, NFS | Eye movement disorders, motor responses | IC, STH electrodes; F-U: 2–60 mo, 20 avg |
| Kumar & Wyant,46 1985 | CS | BP, CP | 18-18-14 | Medtronic, 50–100 Hz, 0.5 ms, 3–4 V | Transient blurred vision | Subthalamic nucleus electrodes; F-U: 6–48 mo |
| Tsubokawa et al,45 1985 | Please see entry in the STH Section | |||||
| Young & Brechner,48 1986 | CS | CP | 17-16-15 | NFS | NFS | STH electrodes; F-U: 1–21 mo 5.8 avg |
| Hosobuchi,47 1986 | CS | TP, AD, PHP, PI, PP, PLP, PCD, BP, LP | 65 PV(A)G, 76 STH: 64 PV(A)G, 252STH, 50 PV(A)G, 44 STH | Medtronic, PAG, 30–30 Hz, 0.2–0.3 ms, 2–4 V; VPLP/VPM, 50–100 Hz, 0.2–0.3 ms, 2–6 V | Dysconjugate vertical eye movements | Use of l-Dopa, l-Tryptophan, F-U: 24–168 mo |
| Baskins et al,93 1986 | CS MC |
CP, PN | 7-7-7I, 6LT | Medtronic, 20 Hz, 1–4 V, NFS | Stimulation tolerance | Confirmed anatomic location; F-U: 1–7 mo |
| Hosobuchi,94 1987 | CS | CP | 7-2-2 | Monopolar electrode, Pulse width 0.5 ms, 0.5–1.5 Amps, 30 Hz | 5 Reported feelings of nausea, fright, piloerection, cold sensation | Stimulation of dorsal PAG |
| Young & Chambi,51 1987 | CS | NFS | 52-45-45I, 29LT | Medtronic, 60 Hz, 0.1–1 ms, NFS | High levels of stimulation tolerance, feeling of warmth, diplopia, oscillopsia | STH electrodes in separate cohort, no Naloxone reversal |
| Levy et al,50 1987 | Please see entry in the STH Section | |||||
| Kumar et al,52 1990 | CS R |
BP, LP, TPS, PN, CP | 48-39-30 | Medtronic, PVG, 25–50 Hz, 0.1–0.5 ms, 1–5 V; VPM/VPLP, 50–100 Hz, 0.2–0.8 ms, 3–8 V | Blurred vision, stimulation tolerance | STH electrodes; F-U: 6–120 mo |
| Gybels & Kupers,53 1993 | CS | TPS, PI, PLP, SCI, FBS | 36-36-22I, 211LT | NFS | ||
| Schvarcz,19 1993 | Please see entry in the Septal Section | |||||
| Tasker & Vilela Filho,95 1995 | CS | NFS | 54-25-15 | NFS | Warmth, pleasure | Ventrocaudal nucleus electrodes; compare PAG vs PVG |
| Kumar et al,31 1997 | CS R |
FBS, PHP, TPS, TN, CP, PLP | 68-53-42 | Medtronic 3280 & 3387, PV(A)G, 25–50 Hz, 0.1–0.5 ms, 1–5 V; STH, 50–100 Hz, 0.2–0.8 ms, 2–8 V | Stimulation tolerance | IC and STH electrodes; F-U: 78 mo avg |
| Nandi et al,59 2002 | CS | PSP | 4-2-2 | Medtronic 3387, 3389, 15 Hz, 0.45 ms, 5 V | Motor response | STH and MC electrodes; failure of MCS in 5/6 |
| Nandi et al,60 2003 | CS | PSP, TN, MS | 8-6-6 | Medtronic 3389, 3387, 5-35 Hz, 210 μs, 1.5–2.5 V | PV(A)AG >50 Hz elicited pain, STH elicited paresthesias | STH electrodes; noted a correlation of thalamic electrical activity and chronic pain, F-U: 3–30 mo, 9 mo avg |
| Green et al,96 2004 | CT P PC RA |
TPS, PLP, PHP | 7-7-4 | Medtronic 3387, NFS | Feeling of warmth | STH electrodes; F-U at 6mo |
| Bittar et al,64 2005 | CS | PLP | 3-3-3 | Medtronic 3387, NFS | STH electrodes; F-U: 8–20 mo | |
| Bittar et al,97 2005 | Meta-analysis: “DBS is frequently effective when used in well-selected patients” | |||||
| Hamani et al,66 2006 | Please see entry in the STH Section | |||||
| Owen et al,67 2006 | CS P |
PSP, PLP, AD, SCI | 34-26-14 | Medtroinic 3387, PVG, 5–30 Hz, 120–450 ms, 0.8–4.5 V; STH, 10–50 Hz, 60–400 ms, 0.7–4.4 V | NFS | STH electrodes |
| Owen et al,68 2006 | CS R |
PSP | 15-12-12 | Medtronic 3387, NFS | Eye bobbing | STH electrodes; F-U: 27 avg |
| Green et al,62 2006 | CS P |
AD, TN, POP | 7-7-5 | Medtronic 3387, 10–50 Hz, 120 μs, <3 V | Feeling of warmth, paresthesias, eye disorders | STH electrodes |
| Rasche et al,69 2006 | CS | FBS, AD, PLP, SCI, PSP, PHP | 56-32-22 | Medtronic 3387, NFS | PVG: feeling of warmth, dizziness, floating, eye deviations, gaze paralysis; STH: paresthesias | STH electrodes; F-U: 12–96 mo |
| Owen et al,70 2007 | CS | PSP, PLP, AD, SCI, MS, PHP, CP | 47-38-32 | Medtronic 3387, PV(A) G, 5–30 Hz, 120–450 ms, 0.8–4.5 V; STH, 10–50 Hz, 60–400 ms, 0.7–4.4 V | PVG: feeling of warmth; STH: paresthesias | STH electrodes; PV(A)G alone or with STH stimulation was most efficacious |
| Owen et al,98 2008 | CS | PSP, PI, STP | 4-3-3 | Medtronic 3387, NFS | NFS | Surgical planning with diffusion tensor imaging |
| Boccard et al,71 2013 | CSP | PLP, STP, PI, PSP, SCI, FP | 85-74-39 | Medtronic 3387, St. Jude 6143, 5–50 Hz, 200–450 μs, 0.5–5 V | NFS | STH electrodes; F-U: 28 mo avg |
Abbreviations: AD, anesthesia dolorosa; BP, back pain; CP, cancer pain; CS, case series; CT, clinical trial; F-U, follow-up; FP, face pain; FBS, failed back syndrome; Hz, Hertz; LP, leg pain; mA, milliampere; MC, multicenter; MS, multiple sclerosis; ms, millisecond; NFS, not further specified; P, prospective; PHP, postherpetic pain; PI, plexus injury; PLP, phantom limb pain; POP, postoperative pain; PP, paraplegia pain; PSP, poststroke pain; R, retrospective; SCI, spinal cord injury; STP, stump pain; TN, trigeminal neuralgia; TPS, thalamic pain syndrome; V, volts.